Discogram and Surgery Consult Results

[iluvthebeach]

I saw the doctor for the discogram results and the ortho surgeron to discuss my options and neither one of them had encouraging news. Dr. Maurer said my l4-l5 disc has a pain level of 7 out of 10 and only handled 28 psi of pressure and my l5-s1 has a pain level of 8 out of 10 and could only handle 25 psi of pressure. He said a normal disc should be able to handle 100 psi of pressure.


Dr. Balderston said my vertabrae above my l5-si disc has slipped back and rubbing on the vertabrae below my l5-s1 disc. My options - 2 level fusion (which my insurance company will pay for) 1 level fusion and 1 level disc replacement (my insurance will pay for each separately but not together) or live with the pain. Gotta check out my options and do some more research. He said that since my insurance company would not pay for the hybrid surgery he would totally recommend the 2 level fusion and didn't think it would adversely affect me. But Dr. Maurer had said that given my condition, he could see the discs going up my back going bad as well. Wouldn't a 2 level fusion start that process sooner rather than later?

It wasn't a good day for me and now I am at a loss as to what I want to do.

[Jstuckey]

So sorry your finding yourself in this same boat so many of us are riding through the rough seas! It makes no sense that your insurance would pay for a fusion and ADR separately, since a second surgery is not only expensive, but a huge risk to yuor health. Appeal and have the surgeon help. They are used to it.

I'm in a similar situation... Waiting on the decision from my 4th and last appeal. (Last, because I won't try anymore). If they say yes to a hybrid, I'll go "out of network" and pay a little more and see what they can do at the best places in the US. If they won't pay, I've pretty much decided on M6 at L3-4 and 4-5, with a STALIF TT at L5-S1 with Nick Boeree in England. It has taken me months to get here to an "almost" decision. If you have the time and patience, it is good to keep digging for info while fighting your insurance!

Best wishes, and keep us updated. I'd be happy to share my process to date, although I have a ways to go to get to the other side and back!

[Harrison]

Hmmm. Well, at least you are learning more about your options -- that's good -- though progress may be slow. Can you talk a little more about this:

"...my vertabrae above my l5-si disc has slipped back..."

What does slipping mean? Instability? Sounds like it. In which case, it should be measured, quantified and explained to you. This could (not saying it does) contribute to instability at other levels as well.

How are your facets? What does your radiology report say anything about the degree of arthritis?

[iluvthebeach]

Harrison,

Yes there is some instability at the l5-s1 level which is why Dr. Balderston said he would only recommend a fusion at that level. When I looked at the CT Scan, it appeared that my upper vertabrae moved back and the back of the bone where the facets are located is touching the back of the lower vertabrae.

As for you other questions, I don't have the answers to them as I was so upset by this appointment I couldn't ask any questions. I really couldn't think. I didn't ask about my facets. I know there is arthritis at the l5-s1 level but to what degree I am not sure. I know I need to go back and speak with the doctor so I will need to start with a new set of questions. Yours for example are a good start. I have no idea what I should be asking at this point so are there other questions I should be asking?

[Harrison]

I understand...I recall my medical appointments through the years. Here's a link to get you started:

Retrolisthesis - Wikipedia, the free encyclopedia

[kennethhoff]

I'm also sorry to hear of your back issues. It is always a tough decision.

Some thoughts: First, you have Dr Balderston who is a real top spine doc. I know Dr Maurer works with him, but I don't know him in person. I used to live in NJ (Princeton) and my best friend lives in Kennett Square, Pa. After I hurt my back, I went back to school as a paralegal (was a computer systems engineer). But I work in health now in Care Management.

One question I first though of was recovery. Would you have to have two separate surgeries, one for fusion and one for ADR if going hybrid? If so, ask doc for a timeline/timeframe of the whole thing. How long for fusion and recovery, then ADR and recovery? It sounds as having both done at the same time is one option. Recovery is often the toughest part and doing a fusion on 2 levels you could recover in one shot.

What are the risks of doing one vs two procedures?

A fusion at L5-S1 is the safest of all levels from all I read. Some things I would be thinking of is: How old am I ? If I am on the young side, hybrid makes sense to keep mobility. I would ask myself: What will one procedure over the other give me? Better mobility, able to something I can't anymore, or is it just pain issue.

Lastly, since you are up in that area, would you get a second opinion from an outside doc rather than Balderston/Maurer? Though they are quite good, sometimes a second opinion outside of the medical community your in is helpful. Dr Bitan in NY is one of the best up there, Dr Yue at Yale is too, and maybe Harrison can suggest others.

But I know I would want to get a strong second opinion outside my current doc with another top doc and get his/her opinion if I could.

Think also about ADR inclusions/non-inclusions list, and your overall health outside your back (eg; your weight, prior back surgeries, other medical conditions like diabetes, high blood pressure, etc ..., smoking?, what kind of support you have, etc ...)

Maybe, if your comfortable with it, post your written report. Easier to get the bigger picture with that.

Best,
Ken

Originally Posted by iluvthebeach

Harrison,

Yes there is some instability at the l5-s1 level which is why Dr. Balderston said he would only recommend a fusion at that level. When I looked at the CT Scan, it appeared that my upper vertabrae moved back and the back of the bone where the facets are located is touching the back of the lower vertabrae.

As for you other questions, I don't have the answers to them as I was so upset by this appointment I couldn't ask any questions. I really couldn't think. I didn't ask about my facets. I know there is arthritis at the l5-s1 level but to what degree I am not sure. I know I need to go back and speak with the doctor so I will need to start with a new set of questions. Yours for example are a good start. I have no idea what I should be asking at this point so are there other questions I should be asking?

[iluvthebeach]

Ken, thank you for your thoughts!

I called to see if I could reports faxed to me but the transcription won't be done until next week. I think I will post them because I think it will help get some answers/questions I need to know.

To answer some of your questions - I am 40 and relatively good health except back issues. Before it started to get very painful, I worked out 5-6 days a week. I don't smoke, rarely drink, and my BP runs low to normal. Right now I am slightly overweight but that is because I can't work out. No back surgeries yet and my support system is awesome.

What do I really want to get out of any type of surgery - to be pain free and get my old life back. LOL I know that is unlikely to happen but I would like to be as "normal" as possible. I don't want to lose mobility since I am so young (ok so maybe I am old to the 20 yr olds) and I don't think I should have to give that up.

As far as doing 2 surgeries, I guess that is a possibility but I am not sure that 2 back surgeries would be recommended. That is something I need to discuss with any doctor I consult with.